Our shoulders are not only our most mobile joint. We can bear weight on them to crawl, climb, vault, do pushups and hand stands. We use them to reach and carry things with our hands. They are the hinge on which our arms swing to keep our balance when walking and running. Their versatility lets us use them to swim, swing racquet, ride bicycles and so much more. If our shoulders don't work right, there are many things that we cannot do.

The shoulder joint is not like the hip, it is not a deep socket with a giant knob of bone deeply set inside. The socket of the shoulder is a shallow divet on the front side of the shoulder blade (scapula), and the armbone (humerus) rests lightly in it, held by muscles and tendons. The arm and shoulder have an incredibly wide range of motion. The whole joint is held together by muscle, sinew, and a bunch of bones that are all together called the shoulder girdle. The collar bones, though small and fragile, are an important part of the shoulder girdle because they keep the shoulders held wide instead of folding forward to the front. The top part of the breastbone is part of the shoulder girdle, because the collar bones attach there to keep the shoulders wide.

The problem with the shoulder is that there are many ways to injure it. You can tear the labrum, which is a piece of cartilage inside the joint that several tendons attach to. You can hurt the small muscles and tendons of the rotator cuff, which are deepest inside the joint and help keep the ball of the armbone (humerus) in its socket. You can rip the ligaments that hold the collarbone in place, most commonly the AC ligament. You can strain big muscles all around the shoulder girdle. You can have many tiny injuries that result in longterm inflammation which causes arthritis and sometimes frozen shoulders. None of these are any fun. You can tear up your shoulders in so many ways that just about everybody has done it before they get old, and many shoulder injuries never heal all the way.

We can do better. Of course prevention is the best approach. It's easier to keep your shoulders in shape than it is to rehabilitate them after you've torn them up. The problem is that we have a hard time caring about problems that haven't happened yet. If you are an athlete or even just a person who cares about being able to function in old age, I encourage you to take care of your shoulders before they are impaired. Learn how to strengthen your rotator cuff and do it regularly, and do activities that involve swinging like a monkey if you can. As my friend Paul Meier says, "Brachiate or disintegrate." It is good to move your shoulders in every way so that you can continue to use them as you age.

When you have a shoulder injury it's OK to rest it, but not forever, and not completely. With exceptions for extreme injuries, you should keep moving in all the ways that you can move. Yes, take breaks from moving your shoulders in certain ways if it hurts, but your goal is of course to regain full range of movement and strength in all the motions that the shoulders can do. If you stop moving your shoulders for too long, that is when they freeze into place. Getting a frozen shoulder loose is extremely painful, so it's better to move it a little even when it hurts a little.

You may know that I am whitewater kayaker. Kayaking is almost as hard on shoulders as throwing and swimming. When you paddle a kayak, not only are you using your shoulders to propel yourself forward using the paddle, but you also use your shoulders to balance the boat by bracing, and to Eskimo roll the boat back up when you flip over. Pretty much all of my kayaking friends have had shoulder injuries, and I have too. Many of my kayaking friends have had shoulder surgeries, too. Over the years I've developed some opinions about shoulder health, and I want to tell you a little bit here.

When you have a shoulder injury, and you go to a doctor, they should ask you to do a lot of different movements and test your strength and range of motion in some strange ways. If they don't do this, go to another doctor. You want a proper shoulder examination, and many primary care doctors don't know much about shoulders. They are complicated, after all, kind of a specialty. A skilled shoulder exam can tell you which parts are injured better than all the fancy imaging in the world.

If the injury is severe enough the doctor may send you to get an MRI. Doctors won't order MRI's unless they think you might need surgery. If you consult a surgeon and get an MRI, they are almost guaranteed to suggest surgery. This is when you should slow down and take a deep breath. You don't always want surgery, even if the surgeon says it is the only way that you will regain function. Take your time, get a second and third opinion, and check around for the best shoulder surgeons in your area. Do not want to rush under the knife just because one doctor said you should. Surgeons do, after all, make their living doing surgery and see it as the solution for most problems. If you take the same injured shoulder to two different shoulder experts you are likely to get two very different assessments, so I encourage you to do just that. If those two assessments are very different, get a third opinion, hoping for a tie breaker.

As I have said, the shoulder joint is a complicated one. There is a giant debate even among shoulder surgeons about what procedures are best and how to do them. I won't get into the details but I will say that my shoulders have recovered several times from injuries that I was told would require surgery. It took a long time. More than a year for a couple of them. That's a lot of time not doing the things I love to do. But if you get shoulder surgery, you will be out of your activities for a very long time, because the rehab for surgery is incredibly slow too. Shoulders are slow. And painful. There is no fix for that, it is just the way it is.

I can help you get through the slow and painful recovery for a shoulder injury. Whether you choose surgery or not, you can facilitate healing by what you eat and drink, how you sleep, and what kinds of movements you do. You can also hurt yourself by overdoing it, especially with weights. Feel free to contact me for help with your shoulders. We all need a little help sometimes.